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There are no evidence\u2010based recommendations for the prophylactic management of children at risk of variceal hemorrhage due to the lack of appropriate randomized controlled trials. In a recent gathering of experts at the American Association for the Study of Liver Diseases annual meeting, significant challenges were identified in attempting to design and implement a clinical trial of primary prophylaxis in children using either of these therapies. These challenges render such a trial unfeasible, primarily due to the large sample size required, inadequate knowledge of appropriate dosing of \u03b2\u2010blockers, and difficulty in recruiting to a trial of endoscopic variceal ligation. Pediatric research should focus on addressing questions of natural history and diagnosis of varices, prediction of variceal bleeding, optimal approaches to \u03b2\u2010blocker and ligation therapy, and alternative study designs to explore therapeutic efficacy in children.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0b013e318205993a","type":"journal-article","created":{"date-parts":[[2011,2,17]],"date-time":"2011-02-17T08:15:35Z","timestamp":1297930535000},"page":"254-261","source":"Crossref","is-referenced-by-count":109,"title":["Primary Prophylaxis of Variceal Hemorrhage in Children With Portal Hypertension: A Framework for Future Research"],"prefix":"10.1002","volume":"52","author":[{"given":"Simon C","family":"Ling","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Hepatology &amp; Nutrition The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Walters","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Hepatology &amp; Nutrition The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J","family":"McKiernan","sequence":"additional","affiliation":[{"name":"The Liver Unit Birmingham Children's Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen B","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Johns Hopkins University Hospital Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guadalupe","family":"Garcia\u2010Tsao","sequence":"additional","affiliation":[{"name":"Digestive Diseases Section Yale University School of Medicine New Haven CT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin L","family":"Shneider","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Children's Hospital of Pittsburgh Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,3]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.21907"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-94-007-1042-9_19"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005176-199907000-00006"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1536-4801.2003.tb12058.x"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2006.00597.x"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2006.00598.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840220145"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840210505"},{"key":"e_1_2_8_10_1","first-page":"140","article-title":"The role of vasoactive mediators in portal hypertension","volume":"6","author":"Garcia\u2010Pagan JC","year":"1995","journal-title":"Semin Gastrointest Dis"},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0022-3565(25)24274-4","article-title":"Differential response of normal and cirrhotic liver to vasoactive agents. 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